Community Health Workers: Champions in the Fight against Child Pneumonia

While the social media sphere has been abuzz with updates and tweets about 11/11/11 – and rightly so, given that it’s Veteran’s Day – the global health community has its eye on the day after.

November 12th marks the annual World Pneumonia Day  for advocacy about the leading cause of death for children under five around the globe.  1.4 million children die each year as a result of pneumonia, and most of those deaths could be averted through simple treatment.

In remote areas, though, families often don’t have the time, money or other resources to access facility-based care. Choosing between taking a child 30 kilometers to a health facility when they show signs of illness and putting food on the table is a reality for many families throughout the developing world. According to Dr. Elizabeth Mason from the World Health Organization, only 30% of children in need of treatment for pneumonia actually receive it. A solution to that challenge of access comes in a form familiar to those in global health sphere:  community-based treatment.

By training health workers to provide simple interventions at the community level, famliies with no immediate access to a health facility could receive care without an undue burden of cost or time.  Well-timed with World Pneumonia Day, The Lancet published a study supported by USAID and conducted by Save the Children, the Boston University Center for Global Health and Development, and the World Health Organization clearly documenting the success of community-based treatment of child pneumonia in Pakistan. Researchers found that the risk of discontinuing or failing to receive treatment was significantly lower for those in the intervention group (receiving community-based care) compared to the control group (only received facility-based care).

New data supporting a promising practice to save lives are wonderful, but will raise questions around the next steps for the global health community, such as:

How does research like this translate into practice? The next challenge will be for WHO to consider revisions to its recommendations for treatment of child pneumonia and include home-based administration of oral antibiotics. Recommendations are made and revised based on large bodies of evidence, including studies like the one noted earlier. To act on any new recommendations will then require global health organizations leverage existing resources to support training community health workers  (CHWs)– either existing cadres or new ones – in this specific treatment protocol.  Notably, numerous organizations and donor agencies are already supporting many community-based programs; the USAID Child Survival and Health Grants Program has some great examples.

What needs to happen as recommendations are being considered and programs designed?  Any number of items, depending on who you are. Two important priorities should be better counting and mapping of existing CHWs and advocacy around why this approach is important – whether programs are implemented today or next year, they will require resources.

Why is mapping and counting CHWs so important? In order to identify where CHWs have already been trained and could be taught additional skills, updated data on the number and location of CHWs around the world is needed. Information is power, particularly when you’re working to deliver services in remote and underserved areas. The most recent data on how many CHWs work in various regions is outdated (more than 6 years old), particularly for an informal work sector with high turnover. That data indicated that more than half of the 100 million trained health workers documented were informal, rather than physicians, nurses, and midwives, according to Dr. Arial Pablo-Mendez, Assistant Administrator for Global Health at USAID. Efforts to document existing cadres of CHWs are moving forward though, which will hopefully provide much needed data on existing human resources for health and their distribution.

What kind of data do we have to advocate for community-based care? From a financial perspective, Mary Beth Powers from Save the Children, indicated it only cost around $300 per health worker for all of the required training around community case management of child pneumonia.  With funding for global health under attack, low-cost/high-impact interventions like these are essential to continue and scale up programs to maximize the number of lives saved.  In addition to saving children’s lives, the community health workers feel empowered, receive increased respect from the community after demonstrating how lives can be saved through their simple actions, and projects build local capacity that will live on beyond the life of the project.

Leaders in the global health community are supporting increases in community –based care for child pneumonia, and have the data to illustrate the potential in these programs. Next up: advocating for integrated community case management of childhood illness (iCCM), which has also been demonstrated to be highly effective and financially smart. On this World Pneumonia Day, consider lending your voice to help combat some of the 1.4 million child deaths that happen each year as a result of this disease.

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